Job Application: Barista

Title: Barista

Fields marked with an asterisk (*) must be filled out before submitting.

Some information about you

First name *
Last name *
Email Address *

Contact Details

Telephone number
Cell phone number
Facebook profile
Referred by


Are you 16 years old or older? * Yes
High School
Did you graduate high school? * Yes
Which year did you graduate?
Did you graduate college? Yes
Which year did you graduate?
Trade, graduate, business or correspondence school, certificate:

Employment History

Current employer:
Current employer phone number:
Previous employer #1:
Previous employer #1 phone number:
Start and end dates:
Reason for leaving:
Previous employer #2:
Previous employer #2 phone number:
Start and end dates:
Reason for leaving:

General Information

Please list sports, clubs, extra curricular activities, organizations, memberships you participated in high school, college, and community:
Please list any skills and qualifications you can bring to Jeremiah Joe Coffee:
What is a latte?
What is espresso?
Do you drink coffee?
What is your favorite coffee drink?
Do you like coffee hot or cold?
Please answer the following questions in 25 words or more per question:
Why are interested in employment at Jeremiah Joe Coffee?
What are one or more things you are most proud of regarding your work or school experience?
Describe a time you made a mistake and how you fixed it:
Name a person you admire and why:
What are your plans in the next 2 years?
AUTHORIZATION: I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered by the Jeremiah Joe Coffee. I understand that any employment is conditioned on a background check. I authorize Jeremiah Joe Coffee to thoroughly investigate all statements contained in my application or resume, and I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to Jeremiah Joe Coffee, without giving me prior notice of such disclosure. In addition, I release Jeremiah Joe Coffee, any former employers and all references listed above from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure. I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an employment contract. I further understand and agree that if I am hired, my employment will be “at will” and without a fixed term, and may be terminated at any time, with or without cause and without prior notice, at the option of either myself or Jeremiah Joe Coffee. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon Jeremiah Joe Coffee unless made in writing by an authorized Jeremiah Joe Coffee representative. If I am offered employment I agree to submit to a medical examination and drug test, if required, before starting work. If employed, I also agree to submit to a medical examination or drug test at any time deemed appropriate by Jeremiah Joe Coffee and as permitted by law. I consent to such examination and tests, and I request that the examining doctor disclose to Jeremiah Joe Coffee the results of the examination, which results shall remain confidential and segregated from my personnel file. I understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical examinations and drug test, if required, and if I am hired a condition of my employment will be that I abide by Jeremiah Joe Coffees Drug and Alcohol Policy. I understand that acceptance of this form does not indicate there is a position open and does not obligate Jeremiah Joe Coffee to hire, I agree to abide by all Jeremiah Joe Coffee work rules, policies and procedures (verbal and written). Jeremiah Joe Coffee retains the right to revise its policies or procedures, in whole or in part, at any time.
Name *
Date *